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APPLICATILA FOR CONSTRUC7.ON PERMIT <br />Lh@ EVBCpreen <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />259.8610 TO BE COMPLETED IN INK —PLEASE PRINT <br />I_I DEMOLITION ✓OMBINATION I I BUILDING I I MECHANICAL PLUMBING <br />OWNER MAR ADDRESS CITY ZIP PHONE <br />TTE.FAltuow Q `MPAtNWRu.. 1'1J51, -100w PL SE EUE12E17 ?0703 <br />CRY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAR ADDRESS <br />GE II �LLeCJO/NjTTRRAALTCTTOOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHME <br />LICE.JEI <br />MECHANICAL CdNTRACTOR <br />MAR ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE F <br />CLASS OF WORK <br />I I NEW ILeADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />TENANT IMPROVEMENT OR INTERIOR 11E161 E <br />jf <br />CONTACT PERSON ANDPHONE 110 <br />^ONI <br />CONTRACT PAK:E OF WORK: q �A GW '• QZG a 0 <br />_ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />eyewslwc gognogair to Rxc awm <br />PROPOSED USE OF OUR DING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />pee gQaq C-519-iiZ <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCBIPTKNI OF PROPERTY»ELermeEteweR 2FfAury�m cove <br />1l <br />�(/j l/LJ,L.,JJ <br />LOT BLOCK ocK lff <br />_ <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />l- a �9 TTi� P�9�JgN <br />_ <br />---"---- <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />-- ---" <br />---- - <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />_. <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGNATURE OF CGNTAACTOII OR AUTHORIZED AGENT DATE <br />x k <br />APPL ICANTS CITY BUSINESS I ICENSE NO AND BUSINESS NAME <br />PROJECT ADORE SS <br />I• � �� ,L <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />S 4OV <br />AIC-A/HNDLG UNITS-H.R <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />; <br />LAVATORY (WASH BASIN) <br />s •��lZ <br />—� <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />L-;Uf. <br />CLOTHES DRYERS <br />KITCHEN SINK 8 OISP <br />S�1 T <br />l <br />VENTILATION FAN <br />1 <br />DISHWASHER <br />_g !C� <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />I_ <br />HEATER <br />' <br />_ <br />CLOTHES WASHER <br />_ <br />—� <br />_WATER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE 6 CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />!— <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />I <br />1 <br />r <br />1 <br />I <br />� <br />I <br />SUB TOTAL $ <br />no <br />SUB TOTAL S <br />PERMIT <br />$ <br />1 <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />T <br />PLAN CITE KNUMBER <br />. <br />FEE <br />Y_._9(' <br />RECEIPT NO. <br />3a 3o <br />.20r <br />20( <br />yoaG <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />I FEES <br />I VALUATION <br />FEE <br />BUILDING <br />%PC el Bo <br />I <br />�.JI./ �l{J <br />- <br />1,60f 0 <br />1 1 YES I I NO <br />TYPE Of COAST ALLOWABLE <br />TYPE OF COAST ACTUAL <br />R'CYMMLY <br />°AO1F <br />wamilA10MAlE <br />v_� <br />PLUMBING <br />SIZE OF BLDG <br />43Z sf )Ex'Jf. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />OTHER/ <br />p0 <br />P&M2066 <br />I I_ <br />YES dd NO-. <br />OCCUPANCY LOAD FIRE SPRLIKLERS REGO <br />KB <br />HEITUMITAVNI <br />STATE BUILDING SURCHARGE <br />��Y <br />igo <br />IIYES MNO I 'G <br />REASON FOR SPRINKLERS <br />r <br />SIATE ENERGY SURCHARGE <br />APPLICATION ACC.BY <br />PLANS APWD BY <br />'� <br />CITY OF EVERETT <br />PITBI IC WORKS <br />zyJ <br />�W <br />LOCAL SALES <br />TAX CODE IS 3105 <br />" <br />5� <br />TOTAL <br />439 <br />